=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033114582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE COMPANY OF MARY HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 04/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3551 VOYAGER ST STE 201
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-303-7496
-----------------------------------------------------
Fax | 310-303-7575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6668
-----------------------------------------------------
City | SAN PEDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90734-6668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-303-7496
-----------------------------------------------------
Fax | 310-303-7575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MRS. ELIZABETH ZUANICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-303-7496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 980000818
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------